MEDICARE: FAITH COUNSELING AND WELLNESS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1669115408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH COUNSELING AND WELLNESS, LLC

Provider Business Mailing Address
First Line	:	13696 STATE HIGHWAY 210
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-5728
Country	:	US
Telephone Number	:	701-425-1457
Fax Number	:

Provider Business Practice Location Address
First Line	:	307 W WASHINGTON ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-2923
Country	:	US
Telephone Number	:	218-821-6296
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TIFFANY CONNER
Credential	:	LMFT
Telephone Number	:	701-425-1457

Provider Enumeration Date	:	04/19/2022
Last Update Date	:	04/19/2022

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Directions to “FAITH COUNSELING AND WELLNESS, LLC ” Practice Location

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